Respiratory management of tracheal injuries is a crucial key to successful treatment. We present herein a patient with a traumatic tracheal transection in whom we confronted difficulty in airway management after false intratracheal intubation. No associated injuries were seen in the patient, then, primary repair of the trachea was carried ...

AIM: To assess whether an airway assessment score based on the LEMON method is able to predict difficulty at intubation in the emergency department. METHODS: Patients requiring endotracheal intubation in the resuscitation room of a UK teaching hospital between June 2002 and September 2003 were assessed on criteria based on ...

PURPOSE: Glottic insertion of the ProSeal Laryngeal Mask Airway (PLMA) has received little attention in the anesthesiology literature. We investigated the incidence and depth of insertion associated with this important cause for a failed insertion attempt with the PLMA. METHODS: With Institutional Review Board approval, we reviewed 15-months' use of ...

Our objective was to assess the effect of orthopedic metallic prostheses on radiation dose associated with MDCT using z-axis automatic tube-current modulation and a fixed tube current in a phantom and patient study. Z-modulation is associated with a 34.1% increase in the mean tube current-time product and no change in ...

OBJECTIVE: The purpose of this study was to investigate the potential use of low-tube-current MDCT virtual bronchoscopy for the evaluation of children with suspected foreign body aspiration. SUBJECTS AND METHODS: Low-tube-current MDCT was performed in 23 patients (10 girls, 13 boys) with a mean age of 3.3 years (9 months-13 ...

The laryngeal tube has a potential role in airway management during anaesthesia or cardiopulmonary resuscitation. In patients with unstable necks, the head and neck may need to be stabilised manually (manual in-line stabilisation), but it is not known whether this procedure affects the ease of insertion of the laryngeal tube. ...

Nasogastric tubes are increasingly used in the management of a diverse group of patients who generally require short-term enteral feeding. Various techniques of insertion have been described emphasizing the fact that as yet there is no simple and safe method. Nasogastric intubation in head and neck cancer patients may be ...

A flexible technique for positioning patients in fixed orientation radiation fields such as those used in neutron capture therapy (NCT) has been developed. The positioning technique employs reference points marked on the patient in combination with a 3D digitizer to determine the beam entry point and a template fitted to ...

BACKGROUND: The effect of patient position on the view obtained during laryngoscopy was investigated. METHODS: 60 morbidly obese patients undergoing elective bariatric were studied. Patients were randomly assigned into one of two groups. In Group 1, a conventional "sniff" position was obtained by placing a firm 7-cm cushion underneath the ...

Successful extended thymectomy was performed in three patients with myasthenia gravis under only high thoracic epidural anesthesia with voluntary breathing. It was not necessary to intubate a tracheal tube during operation for any of the patients. Neither muscle relaxants nor volatile anesthetic agents were required. The mean operating time was ...

Pneumonia remains a significant cause of morbidity and mortality in surgical patients. Though most studies have focused on pneumonia in trauma or special respiratory intensive care units (ICU), we examine postoperative ventilator-associated pneumonia in patients undergoing elective operations. We hypothesized that a study of multiple clinical variables would disclose factors ...

BACKGROUND/AIMS: Bile leak remains a serious complication after major hepatectomy. The usefulness of external biliary drainage to prevent intraperitoneal bile leak was studied. METHODOLOGY: Thirty-nine patients who underwent major hepatectomy from April 1997 through June 2000 were studied. The bile leak test was performed to identify and close leaks following ...

BACKGROUND: Arytenoid hypertelorism (arytenoid cartilages spaced too widely apart) appears to be the most common initial recognizable physical finding of cricoid chondrosarcoma. Nine cases from the Center for Voice Disorders are presented. With arytenoid hypertelorism caused by cricoid chondrosarcoma, usually the posterior larynx is open. In fact, patients with arytenoid ...

In some situations, patients need endotracheal intubation to maintain airway patency while they are constrained in the lateral position. In this study we compared lightwand-guided intubation of 120 randomly enrolled patients placed in the supine, right, or left lateral position. Group S patients were initially placed in the supine position, ...

OBJECTIVES: The aim of this prospective study in the prehospital setting was to compare three different methods for immediate confirmation of tube placement into the trachea in patients with severe head injury: auscultation, capnometry, and capnography. METHODS: All adult patients (>18 years) with severe head injury, maxillofacial injury with need ...

Intracranial insertion of a nasopharyngeal airway is an unusual and catastrophic complication of airway management in the patient with a severe closed head injury. We present an unfortunate 43-year-old patient with intracranial insertion of a nasopharyngeal airway during trauma resuscitation. The nasopharyngeal airway was removed. Attempts to resuscitate the patient ...

OBJECTIVE: It has been shown that many healthy people aspirate secretions at night. Patients with obstructive sleep apnea (OSA) have frequent episodes of gasping at night that may predispose them to aspiration. The purpose of this study was to determine whether patients with symptoms of OSA are predisposed to pharyngeal ...

A comprehensive anesthetic plan for managing patients undergoing "awake: intracranial surgery (AICS) must include a means of rescuing the patient if the airway becomes obstructed. Since access to the patient's airway is limited, mask ventilation can be challenging and laryngoscopy and tracheal intubation, impossible. The need exists for an alternative ...

BACKGROUND: Poor positioning of an endobronchial double lumen tube (DLT) could affect oxygenation during one lung ventilation (OLV). We set out to relate DLT position to hypoxaemia and DLT misplacement during OLV. METHODS: We recruited 152 ASA physical status I-II patients about to have elective thoracic surgery. The trachea was ...

Evaluation of tube position is important after in-hospital and prehospital emergency intubation. Colorimetric breath indicators are devices for immediate control of tube positioning by showing a color change according to end-tidal CO2 (ETCO2) concentrations. We hypothesized that colorimetric breath indicators can yield reliable results for confirmation of tube position. The ...

Airway management may be difficult in acromegalic patients. The purpose of the study was to evaluate the intubating laryngeal mask airway (ILMA) as a primary tool for ventilation and intubation in acromegalic patients. Twenty-three consenting consecutive adult acromegalic patients presenting for transsphenoidal resection of pituitary adenoma were enrolled in the ...

BACKGROUND: Explicit recall (ER) is evident in approximately 0.2% of patients given general anaesthesia including muscle relaxants. This prospective study was performed to evaluate if cerebral monitoring using BIS to guide the conduction of anaesthesia could reduce this incidence significantly. PATIENTS AND METHODS: A prospective cohort of 4945 consecutive surgical ...

Vocal Fold Dysfunction is a syndrome characterized by abnormal adduction of the focal folds during inspiration and is the cause of a wide spectrum of clinical manifestations ranging from mild inspiratory stridor to an inability to move any air. Patients present with varying degrees of intermittent respiratory difficulty, the most ...

OBJECTIVE: To determine the incidence, reasons and prognosis about Horner's syndrome in thoracic surgical patients. METHODS: In this prospective clinical study, 933 adult patients were assessed between the years of 1998 and 2002. All patients who underwent chest tube insertion (n: 662 patients) or thoracotomy (n: 342 patients), or who ...

The primary goal of intervention for patients with dysphagia is to restore oral feeding. When patients are unable to achieve adequate nutrition, hydration, or safety with oral feeding, then nonoral approaches are often recommended. Although patients' rights to accept or refuse clinical recommendations are widely recognized, when a patient refuses ...

In 50 morbidly obese patients, we quantified the soft tissue of the neck from the skin to the anterior aspect of the trachea at the vocal cords using ultrasound. Thyromental distance, mouth opening, limited neck mobility, modified Mallampati score, abnormal upper teeth, neck circumference and sleep apnoea were assessed as ...

Temporary dysphagia affects up to 50% of stroke patients in the acute stage of their illness and often necessitates tube feeding. In these patients, the placing of nasogastric tubes is often difficult or impossible. This study evaluated the efficiency and tolerability of a previously described new method for tube placing, ...

BACKGROUND: Empyema thoracis is a common illness with significant morbidity and mortality. Standard treatment of Empyema includes tube drainage and antibiotics. But the tube drainage often fails if the fluid is loculated. Intrapleural Streptokinase has been used in multiloculated empyemas with good success rate. We evaluated the efficacy and safety ...

Patients with cervical spinal cord injuries (CSCIs) often develop acute respiratory failure and require intubation. It is unknown if intubation should be offered preemptively in all CSCI patients or selectively based on signs of acute respiratory failure. The purpose of this study was to evaluate the role of routine early ...

We report a successful PEG tube insertion in a patient with an LVAD. Adequate prolonged nutritional support was provided. PEG placement in patients with an implantable or paracorporeal LVAD may be possible but present additional concerns. We believe that PEG placement should be cpnsidered in patients with an LVAD with ...

The major clinical impact of vascular rings in children is tracheal compression, which presents with recurrent symptoms of stridor, noisy breathing, and wheezing. This study tests the hypothesis that symptomatic patients have altered tracheal geometry compared to nonsymptomatic individuals. We retrospectively reviewed the tracheal dimensions (area and longest and shortest ...

The purpose of this study is to describe negative pressure pulmonary oedema due to undetected tracheal tube obstruction in a paediatric patient. A healthy 6 week-old scheduled for release of tongue-tie under general anaesthesia was noticed to be diagnosed at the preparation of the surgical site. The patient was quickly ...

BACKGROUND: The laryngeal tube has a potential role during anaesthesia, but there have been only a few studies assessing its efficacy during the entire course of anaesthesia, and all previous studies used prototypes. We studied 100 patients to assess the efficacy of a new laryngeal tube during the entire course ...

Cervicofacial necrotizing fasciitis is a necrotizing soft tissue infection of face and neck spreading at the level of fascia. It has been described as a putrid ulcer, phagedaena, and hospital gangrene. It has a high mortality rate, and presents a challenge to anesthesiologists who must secure an airway to deliver ...

To investigate differences in drainage amounts and early clinical outcomes associated with the use of Silastic drains, as compared with the conventional chest tube after coronary artery bypass grafting (CABG). Retrospective nonrandomized case control study. A tertiary teaching hospital. Outcome data from 554 patients who underwent postoperative pericardial decompression using ...

To describe a new method of catheter insertion in intradiscal electrothermal therapy, which eliminates the need for reinsertion of the cannula and catheter from the contralateral side in those patients in whom optimal positioning is not achieved with the standard technique. This new technique has not been described before. In ...

We evaluated the modified Airway Management Device (AMDTM) in 60 spontaneously breathing anaesthetised patients. The insertion and removal of the device was very easy and atraumatic. The airway was secured on the first attempt in 41 patients (70%; 95% CI 57-80%). The most important problem was loss of airway, which ...

OBJECTIVE: The purpose of our investigation was to determine the relationship between the degree of swallowing dysfunction observed on barium studies and the likelihood of developing pneumonia in a large series of patients. MATERIALS AND METHODS: The findings on videofluoroscopic swallowing studies in 381 patients were used to classify these ...

BACKGROUND: To date, no study has explored the effect of bent length on lightwand intubation. For successful intubation in daily practice, the authors found that bent length should be approximated to the patient's thyroid prominence-to-mandibular angle distance (TMD), but some patients have a TMD much shorter than the suggested bent ...

BACKGROUND: In a previous study we showed that prolonged nasogastric tube feeding is associated with pathogenic oral flora. OBJECTIVE: To reexamine the impact of prolonged nasogastric tube feeding on the oral microbiota and to explore the salivary flow and composition in elderly patients in long-term care. METHODS: We compared a ...

We studied the effectiveness of the intubating laryngeal mask airway (ILMA) in morbidly obese patients scheduled for bariatric surgery. We included 118 consecutive morbidly obese patients (body mass index, 45 +/- 5 kg/m(2)). After the induction of general anesthesia, the laryngeal view was classified by the first observer according to ...

The neuromuscular diseases, such as infantile spinal muscular atrophy, Duchenne's muscular dystrophy, and amyotrophic lateral sclerosis, are widely considered to be terminal illnesses. However, as with many neuromuscular and neurologic diseases, morbidity and mortality are caused by dysfunction of inspiratory, expiratory, and bulbar musculature. This article will discuss how inspiratory ...

Methemoglobinemia is a potential negative side effect associated with the use of benzocaine for topical anesthesia. A healthy patient admitted for an outpatient orthopedic procedure developed the clinical symptomatology of methemoglobinemia after topicalization of the airway with benzocaine. The patient subsequently responded to appropriate treatment and was fit for discharge ...